Psychotherapeutic interventions for chronic pain: Evidence, rationale, and advantages

2018 ◽  
Vol 54 (2) ◽  
pp. 140-149 ◽  
Author(s):  
Muhammad Hassan Majeed ◽  
Ali Ahsan Ali ◽  
Donna M Sudak
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Behavioral Therapy ◽  
Health Resources ◽  
Opioid Use ◽  
Medical Problems ◽  
Pharmacological Management ◽  
Acceptance And Commitment ◽  
Primary Care Clinicians ◽  
The Individual

Background Long-term use of opioids to treat chronic pain incurs serious risks for the individual—including misuse, abuse, addiction, overdose and death—as well as creating economic, social, and cultural impacts on society as a whole. Chronic pain and substance use disorders are often co-morbid with other medical problems and at the present time, primary care clinicians serve most of this population. Primary care clinicians would benefit from having alternatives to opioids to employ in treating such patients. Method We electronically searched different medical databases for studies evaluating the effect of nonpharmacological treatments for chronic pain. We describe alternative approaches for the treatment of chronic pain and cite studies that provide substantial evidence in favor of the use of these treatments. Results Cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based programs have well-documented effectiveness for the treatment of chronic nonmalignant pain. Integration of such behavioral health therapies into primary care settings may optimize health resources and improve treatment outcomes. Conclusion Evidence-based psychotherapy for chronic pain has established efficacy and safety and improves quality of life and physical and emotional functioning. Such interventions may be used as an alternative or adjunct to pharmacological management. Chronic opioid use should be reserved for individuals undergoing active cancer treatment, palliative care, or end-of-life care.

How opioid prescribing policies influence primary care clinicians’ treatment decisions and conversations with patients with chronic pain

2021 ◽  
Vol 17 (6) ◽  
pp. 499-509
Author(s):  
Elizabeth C. Danielson, PhD ◽  
Christopher A. Harle, PhD ◽  
Sarah M. Downs, MPH ◽  
Laura Militello, MA ◽  
Olena Mazurenko, MD, PhD
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Treatment Decisions ◽  
Healthcare Organizations ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Prevention Guideline ◽  
Multistep Process ◽  
Primary Care Clinicians ◽  
Noncancer Pain

Objective: The 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain aimed to assist primary care clinicians in safely and effectively prescribing opioids for chronic noncancer pain. Individual states, payers, and health systems issued similar policies imposing various regulations around opioid prescribing for patients with chronic pain. Experts argued that healthcare organizations and clinicians may be misapplying the federal guideline and subsequent opioid prescribing policies, leading to an inadequate pain management. The objective of this study was to understand how primary care clinicians involve opioid prescribing policies in their treatment decisions and in their conversations with patients with chronic pain.Design: We conducted a secondary qualitative analysis of data from 64 unique primary care visits and 87 post-visit interviews across 20 clinicians from three healthcare systems in the Midwestern United States. Using a multistep process and thematic analysis, we systematically analyzed data excerpts addressing opioid prescribing policies.Results: Opioid prescribing policies influenced clinicians’ treatment decisions to not initiate opioids, prescribe fewer opioids overall (theme #1), and begin tapering and discontinuation of opioids (theme #2) for most patients with chronic pain. Clinical precautions, described in the opioid prescribing policies to monitor use, were directly invoked during visits for patients with chronic pain (theme #3).Conclusions: Opioid prescribing policies have multidimensional influence on clinician treatment decisions for patients with chronic pain. Our findings may inform future studies to explore mechanisms for aligning pressures around opioid prescribing, stemming from various opioid prescribing policies, with the need to deliver individualized pain care.

scholarly journals An evaluation of the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy for opioid use disorder and chronic pain

2019 ◽  
Vol 194 ◽  
pp. 460-467 ◽  
Author(s):  
Declan T. Barry ◽  
Mark Beitel ◽  
Christopher J. Cutter ◽  
David A. Fiellin ◽  
Robert D. Kerns ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Opioid Use Disorder ◽  
Cognitive Behavioral ◽  
Opioid Use

scholarly journals Interactive use of online health resources: a comparison of consumer and professional questions

2016 ◽  
Vol 23 (4) ◽  
pp. 802-811 ◽  
Author(s):  
Kirk Roberts ◽  
Dina Demner-Fushman
Keyword(s):  
Language Processing ◽  
Information Access ◽  
Health Resources ◽  
Background Information ◽  
Special Focus ◽  
Health And Wellness ◽  
Medical Problems ◽  
Online Resource ◽  
The Individual ◽  
Processing Techniques

Abstract Objective To understand how consumer questions on online resources differ from questions asked by professionals, and how such consumer questions differ across resources. Materials and Methods Ten online question corpora, 5 consumer and 5 professional, with a combined total of over 40 000 questions, were analyzed using a variety of natural language processing techniques. These techniques analyze questions at the lexical, syntactic, and semantic levels, exposing differences in both form and content. Results Consumer questions tend to be longer than professional questions, more closely resemble open-domain language, and focus far more on medical problems. Consumers ask more sub-questions, provide far more background information, and ask different types of questions than professionals. Furthermore, there is substantial variance of these factors between the different consumer corpora. Discussion The form of consumer questions is highly dependent upon the individual online resource, especially in the amount of background information provided. Professionals, on the other hand, provide very little background information and often ask much shorter questions. The content of consumer questions is also highly dependent upon the resource. While professional questions commonly discuss treatments and tests, consumer questions focus disproportionately on symptoms and diseases. Further, consumers place far more emphasis on certain types of health problems (eg, sexual health). Conclusion Websites for consumers to submit health questions are a popular online resource filling important gaps in consumer health information. By analyzing how consumers write questions on these resources, we can better understand these gaps and create solutions for improving information access. This article is part of the Special Focus on Person-Generated Health and Wellness Data, which published in the May 2016 issue, Volume 23, Issue 3.

Neuroimaging Correlates for Psychological and Chronic Pain Experiences

2020 ◽  
pp. 121-134
Author(s):  
John A. Sturgeon ◽  
Katherine T. Martucci
Keyword(s):  
Chronic Pain ◽  
Behavioral Therapy ◽  
Structure And Function ◽  
Neural Structure ◽  
Psychological Therapies ◽  
Acceptance And Commitment ◽  
Physical Dysfunction ◽  
Brain Structure And Function ◽  
Pain Experiences ◽  
And Function

Psychological factors play a key role in the pain experience. Clinical and experimental research has highlighted altered behavioral, cognitive, and emotional responses as endemic in chronic pain populations, which contribute to physical dysfunction and to depression, anxiety, and other psychiatric disorders. Neuroimaging research has complemented the knowledge in this domain by identifying how neural structure and function are altered in chronic pain. Brain processes related to mental illness, emotion, memory, and cognition are distributed throughout the brain and modulate pain processing in both the acute and chronic states. These processes can be targeted both behaviorally and neurophysiologically through noninvasive and nonpharmacological psychological therapies, including cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based stress reduction. Psychological therapies are further supported by emerging neuroimaging research that demonstrates changes in brain structure and function associated with positive changes in patients’ responses to pain and overall improved quality of life.

scholarly journals MECHANISM OF ACTION: AGE DIFFERENCES IN RESPONSE TO ACCEPTANCE AND COMMITMENT THERAPY FOR CHRONIC PAIN

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S809-S809
Author(s):  
Julie L Wetherell ◽  
Matthew Herbert ◽  
Niloofar Afari
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
Acceptance And Commitment Therapy ◽  
Behavioral Therapy ◽  
Pain Interference ◽  
Younger Adults ◽  
Pain Acceptance ◽  
Commitment Therapy ◽  
Acceptance And Commitment

Abstract A recent randomized comparison of Acceptance and Commitment Therapy (ACT) vs. Cognitive-Behavioral Therapy for chronic pain found a clear age interaction effect, such that older adults benefitted more from ACT. In a subsequent study comparing ACT delivered in person to ACT delivered via telehealth to a sample of veterans (N=128, mean age 51.9, SD 13.3, range 25-89), we found no significant age by modality interactions, suggesting that older veterans responded as well as younger people did to telehealth delivery. Consistent with our previous findings, we found a trend for older adults to experience greater reduction in pain interference (p = .051) and significantly greater reduction in pain severity (p = .001) than younger adults following ACT. In younger veterans, change in pain acceptance from baseline to posttreatment was related to change in pain interference from baseline to 6-month follow-up (r = -.38), but change in pain interference from baseline to posttreatment was not related to change in pain acceptance from baseline to follow-up (r = .14), suggesting that, consistent with the ACT model, increased pain acceptance at posttreatment was related to reduced pain interference at follow-up. By contrast, in older veterans, both correlations were significant and of comparable magnitude (rs = -.43 and -.46, respectively), providing no support for the idea that change in pain acceptance drove change in pain interference. Overall, our findings suggest that ACT may work better in older adults with chronic pain than in younger adults, but via a different mechanism.

scholarly journals Understanding how primary care clinicians make sense of chronic pain

2018 ◽  
Vol 20 (4) ◽  
pp. 575-584 ◽  
Author(s):  
Laura G. Militello ◽  
Shilo Anders ◽  
Sarah M. Downs ◽  
Julie Diiulio ◽  
Elizabeth C. Danielson ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Primary Care Clinicians

scholarly journals Inequities in access to primary care among opioid recipients in Ontario, Canada: A population-based cohort study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (6) ◽  
pp. e1003631
Author(s):  
Tara Gomes ◽  
Tonya J. Campbell ◽  
Diana Martins ◽  
J. Michael Paterson ◽  
Laura Robertson ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Cohort Study ◽  
Prescription Opioid ◽  
Opioid Use ◽  
High Quality ◽  
Significant Difference ◽  
Ed Visits ◽  
Access To Primary Care

Background Stigma and high-care needs can present barriers to the provision of high-quality primary care for people with opioid use disorder (OUD) and those prescribed opioids for chronic pain. We explored the likelihood of securing a new primary care provider (PCP) among people with varying histories of opioid use who had recently lost access to their PCP. Methods and findings We conducted a retrospective cohort study using linked administrative data among residents of Ontario, Canada whose enrolment with a physician practicing in a primary care enrolment model (PEM) was terminated between January 2016 and December 2017. We assigned individuals to 3 groups based upon their opioid use on the date enrolment ended: long-term opioid pain therapy (OPT), opioid agonist therapy (OAT), or no opioid. We fit multivariable models assessing the primary outcome of primary care reattachment within 1 year, adjusting for demographic characteristics, clinical comorbidities, and health services utilization. Secondary outcomes included rates of emergency department (ED) visits and opioid toxicity events. Among 154,970 Ontarians who lost their PCP, 1,727 (1.1%) were OAT recipients, 3,644 (2.4%) were receiving long-term OPT, and 149,599 (96.5%) had no recent prescription opioid exposure. In general, OAT recipients were younger (median age 36) than those receiving long-term OPT (59 years) and those with no recent prescription opioid exposure (44 years). In all exposure groups, the majority of individuals had their enrolment terminated by their physician (range 78.1% to 88.8%). In the primary analysis, as compared to those not receiving opioids, OAT recipients were significantly less likely to find a PCP within 1 year (adjusted hazard ratio [aHR] 0.55, 95% confidence interval [CI] 0.50 to 0.61, p < 0.0001). We observed no significant difference between long-term OPT and opioid unexposed individuals (aHR 0.96; 95% CI 0.92 to 1.01, p = 0.12). In our secondary analysis comparing the period of PCP loss to the year prior, we found that rates of ED visits were elevated among people not receiving opioids (adjusted rate ratio (aRR) 1.20, 95% CI 1.18 to 1.22, p < 0.0001) and people receiving long-term OPT (aRR 1.37, 95% CI 1.28 to 1.48, p < 0.0001). We found no such increase among OAT recipients, and no significant increase in opioid toxicity events in the period following provider loss for any exposure group. The main limitation of our findings relates to their generalizability outside of PEMs and in jurisdictions with different financial incentives incorporated into primary care provision. Conclusions In this study, we observed gaps in access to primary care among people who receive prescription opioids, particularly among OAT recipients. Ongoing efforts are needed to address the stigma, discrimination, and financial disincentives that may introduce barriers to the healthcare system, and to facilitate access to high-quality, consistent primary care services for chronic pain patients and those with OUD.

scholarly journals (357) Impact of the Harborview Integrated Pain Care Program on primary care clinicians’ perceived confidence to care for patients with complex chronic pain

2017 ◽  
Vol 18 (4) ◽  
pp. S64
Author(s):  
I. Lesnik ◽  
S. Jackson ◽  
J. Huntington ◽  
J. Ballantyne ◽  
A. Nowlin ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Care Program ◽  
Primary Care Clinicians ◽  
Pain Care
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